By: Mildred Galarpe, Sunstar.com.ph
THE last thing Lau remembered were the cries of his grade three pupils, shaking him and tapping his legs before he totally lost consciousness. When consciousness came back, he was in his hospital bed in the intensive care unit of a local hospital.
Lauron “Lau” Montezzola, a 38-year-old school teacher, had no indication that his heart was in danger. On an August morning in 2024, while in the midst of teaching, he was abruptly struck by a sharp, searing pain in his left leg that sent him down to the floor. His students quickly rushed to his side. As they helped him stand, he became dizzy and described a crushing sensation in his chest, as if his heart were being forcefully squeezed. Within moments, amid the tearful cries of his pupils, he collapsed once more—struggling for breath—before ultimately losing consciousness.
The culprit? A silent buildup of cholesterol in his arteries, leading to an undetected case of Atherosclerotic Cardiovascular Disease (ASCVD).
In the Philippines, ischemic heart disease (IHD) remained the leading cause of death for the past five years, data from the Philippine Statistics Agency showed. Even during the pandemic, IHD claimed more lives than any other illness.
This trend is showing the same in Central Visayas, with cardiovascular diseases accounting for 89% of the top leading cause of death in the region, said Dr. Joan Antonette R. Albito of the Department of Health (DOH) – Central Visayas Center for Heart Diseases (CVCHD).
Albito said it is important to note that in the top 10 causes of death in the region, there are two more diseases that are related to cardiovascular disease.
Many people remain unaware of its primary culprit: cholesterol buildup in the arteries.
Unlike some diseases that show clear symptoms, ASCVD is silent. Dr. Marc Louie Del Rosario, Interventional Cardiologist and Head of the Cardiac Catheterization Laboratory at the Asian Hospital and Medical Center, said cardiovascular diseases claim more lives than diabetes, kidney diseases, respiratory diseases, and cancer combined.
Dr. Lourdes Ella Santos, head of Preventive Cardiology at Cardinal Santos Medical Center and the only lipidiologist in the country, emphasized that high cholesterol levels are a major contributor to ASCVD.
Del Rosario said atherosclerosis results from the accumulation of cholesterol in the vessel wall throughout the life course.
Arteries are like water pipes that must remain clean and wide, ensuring safe, potable water reaches every household—just as clear arteries circulate blood throughout the body, Del Rosario said.
However, over time, rust and residue build up in water pipes, resulting in slow current and limited supply of water—just like fat and sticky deposits start clogging the blood vessels. That’s what high cholesterol does—it builds up, narrowing the passage until it blocks completely, causing a heart attack or stroke.
Del Rosario said many people do not experience symptoms until the age of 40, 50, or later, when blockages become severe enough to restrict blood flow.
He added that buildup does not happen overnight; rather, it is the long-term accumulation that eventually leads to major cardiovascular events.
Know your numbers
Both Del Rosario and Albito emphasized the need for early screening and knowing the individual’s risk factors in order to lower cholesterol (LDL) as soon as possible, as much as possible, and for as long as possible.
Albito said heart disease is preventable and can be modified through lifestyle change. She said Filipinos need to change the mindset and health-seeking behavior.
“Anha na magpa check up kung aduna nay simtomas (Only get a check-up when symptoms appear), which could already be late. We need to remember that prevention is better than cure, especially for those who have a family history of the disease,” Albito said.
Know your cholesterol
Speaking at the recent “Unblock Your Heart, Unfriend Your Bad Cholesterol” seminar, Santos explained that while cholesterol is essential for bodily functions, an imbalance can be life-threatening.
Santos stressed that knowing the three components and which component is elevated is crucial in assessing overall cholesterol levels.
Cholesterol consists of three key components: triglycerides are a type of fat (lipid) found in the blood that serve as a key source of energy, but high levels can increase the risk of heart disease.
Santos said triglycerides should not exceed 150 mg/dL. Excessive sugar and carbohydrate intake, lack of physical activity, and excessive alcohol consumption can cause high triglycerides.
In the Philippines, according to a survey conducted by the Philippine Lipid and Atherosclerosis Society (PLAS), one half of men and one third of women have elevated triglyceride levels.
High triglycerides will result in insulin resistance and diabetes, increase the risk of atherosclerosis (narrowing of arteries), and contribute to heart disease.
Santos said to lower triglycerides intake of sugar and refined carbs like white bread, soda, and pastries should be reduced to manage diabetes and insulin resistance.
HDL (High-Density Lipoprotein) is often called the “good cholesterol” because it helps remove excess cholesterol from the bloodstream, reducing the risk of heart disease and stroke.
Santos said HDL’s are the “basureros”; they clean bad cholesterol in the blood, and the more HDL in the blood, the better. She added that more HDL reduces plaque buildup narrowing the arteries.
HDL numbers should not be more than 40 mg/dL for men and 50 mg/dL for women.
To increase the level of HDL, Santos recommended eating healthy fats like those found in olive oil, avocados, nuts, and fatty fish (salmon, tuna, mackerel); regular exercise; quitting smoking; and maintaining a healthy weight.
Santos also pointed out that there is no medication specifically designed to increase HDL, and there is no clinical trial evidence that fish oil increases HDL; that is why it is not recommended.
In the Philippines, Plas survey showed that 63 percent of men and 78 percent of women have low HDL levels.
In contrast, LDL (low-density lipoprotein), often referred to as “bad cholesterol,” can accumulate in the arteries, forming plaques that restrict blood flow. Over time, this buildup can narrow or block arteries, increasing the risk of heart disease, stroke, and other cardiovascular conditions.
Having an unhealthy diet or high intake of saturated fats, trans fats, and cholesterol-rich foods like hamburgers, french fries, and fried chicken can increase high LDL.
Lack of exercise, obesity, smoking and excessive alcohol consumption elevate LDL levels.
LDL should not be more than 30 mg/dL and maintaining this number will cut the risk of having a heart attack or stroke by 30 percent.
Santos urged the public to be proactive in managing their cholesterol levels through a healthy diet and regular exercise to reduce their risk of cardiovascular disease.
Know your risk
Santos and Del Rosario both stressed that it is not enough to know your cholesterol numbers but also to know your risk factors.
According to Del Rosario, men get diagnosed early with heart problems and plaque on the arteries compared to women because of the hormones of menstruation. Menstruation of women helps lower cholesterol and protect arteries from plaque, but as soon as it stops, high blood pressure and high cholesterol increase exponentially and result in a high risk of cardiovascular disease, which is the reason why post-menopausal is a risk factor for women with heart problems.
This is the case of Tita Caballes, who made a tough decision to ensure her heart is in good condition.
“Tatits,” to her friends, was no stranger to life’s challenges. A former sales professional and cancer survivor, her health struggles began long before her battle with cancer. At 50, she experienced severe palpitations, so intense that she struggled to speak. Her doctor attributed it to menopause and recommended Hormone Replacement Therapy (HRT) to ease her symptoms. However, HRT carried a known risk: an increased chance of developing breast and uterine cancer.
Faced with a difficult choice, Tatits weighed her options. Doing nothing meant an increased risk of a heart attack, while taking HRT could elevate her cancer risk. She ultimately chose HRT, reasoning that a heart attack could strike without warning, while cancer, if detected early, could be treated.
“Mahadlok ta sa cancer, pero mas nahadlok ko sa heart attack (We are scared of cancer, but I was more afraid of the heart attack),” Tatits admitted, adding that a heart attack can strike anytime and anywhere, silently attacking without warning.
For eight months, Tatits remained on HRT and was finally free from palpitations until today, and she is now 73 years old. However, on April 10, 2021, amid the Covid-19 pandemic, she was diagnosed with stage IV breast cancer. Despite the challenges of going through the cancer therapies at the time of the pandemic and the high cost of treatment, with the support of her doctors and family, she was cleared of cancer a year after.
“I am not sure if I would have lived this long had I not decided to address my heart problem and just continue to be afraid of something that might happen, like cancer,” Tatits said.
The risk factors for cardiovascular disease include male, post-menopausal women, history of smoking, hypertension, family history of premature coronary heart disease, proteinuria (high amount of protein in urine), and left ventricular hypertrophy.
Dr. Santos outlined three key criteria for initiating cholesterol-lowering medication to prevent cardiovascular disease: Age: Individuals aged 40 to 75 years are at a higher risk for cardiovascular events. Elevated LDL-C: An LDL-C level of 190 mg/dL or higher is considered significantly elevated. Additional Risk Factors: These include conditions such as diabetes, hypertension, smoking, or a family history of heart disease.
Santos said if you meet these criteria, it’s advisable to consult with your healthcare provider to discuss the potential benefits of starting cholesterol-lowering medication. Your doctor can assess your individual risk and determine the most appropriate treatment plan for you.
Lifestyle change
DOH in Central Visayas noted that patients with cardiovascular diseases are getting younger. Albito said cases monitored showed CVD patients were as young as 23 and in their 30s.
A sedentary lifestyle is the common element to most CVD patients regardless of age. “It’s actually very simple; it starts with a lifestyle change,” she said, explaining the need for a consistent healthy diet and exercise.
“Actually, you don’t need to go to the gym or to the plaza to exercise, jog, or walk. Naa nay daghan exercises available online that can be done at home,” Albito said.
She said often, those who contract CAD are office workers who are firmly at their desks all day long, and those whose leisure time involves gadgets that put the body in an inactive state.
Albito said there are also cases of structural heart defects, which means genetics play a crucial role in determining an individual’s ailment as they grow older.
Healthy habits
Avoidance of drinking excessive amounts of alcohol, stress management, and getting enough rest or sleep are also key to living healthy and rejecting the dangers of CVD.
“I know you would say that it’s difficult because you already have established habits. But it takes small steps at a time, and with consistency, you will eventually learn healthy habits,” Albito said.
The government has been campaigning for Pinggang Pinoy, a healthy food plate for Filipinos showing the right portion and sizes of food groups, like one half of the plate should be for fruits and vegetables and the other half should be for rice and protein.
This campaign has been complemented by the #PHAPUSOMUNA campaign and #52100, said Dr. Karen Caudor, president of the Philippine Heart Association (PHA) Cebu Chapter.
Caudor explains what #PHAPUSOMUNA stands for: Pagkain ng masustansiya (eat healthy), Huwag manigarilyo (don’t smoke), Aktibong pamumuhay (active lifestyle), Presyon at kontrolin (control blood pressure), Uminom ng maintenance (drink maintenance medicines), Sugar as kontrolin (control sugar intake), Obesity ay iwasan (avoid obesity), Matulog nang kompleto—seven to nine hours (complete sleep of seven to nine hours). Umiwas sa stress (Stay away from stress). No to alcohol. Ayawan ang cholesterol (Say no to cholesterol).
The #52100 campaign, on the other hand, is for eating five servings of fruits and vegetables, limiting screen time to two hours, engaging in at least one hour of physical activity, consuming zero sugar drinks, and having zero or no smoking.
The PHA Cebu chapter, Caudor said, has been doing information campaigns in partnership with different schools on awareness about heart health.
Government services
Albito, meanwhile, said various government services are in place at the barangay level up to the tertiary hospitals to help patients with heart problems.
Albito said the Konsulta package is available to all Philhealth members, which is a primary care benefit package that offers free or low-cost health services that include consultations, diagnostic tests, and medications.
She added that even if you are not a Philhealth member, these services are still available in barangay health centers and rural health units. One just has to visit the health providers in their barangays or towns.
According to Philhealth, 90 percent of cities and municipalities in Central Visayas already have an accredited Konsulta provider from Jan. 1 to Dec. 31, 2024. Recent expanded Philhealth benefits for ischemic heart disease and acute myocardial infarction are from P21,900 to P523,853.
“What is needed really is awareness to the public; heart disease is preventable, and the solution is really within reach if we just learn to listen, learn, and take action,” Albito said.
Treating a heart attack is very expensive; preventing it is much cheaper, said Joel Chong, country president of Novartis, an innovative medicine company.
Chong said the best outcome from treatment and medication comes when a person makes informed decisions, and this is where the challenge of misinformation arises.
“Misinformation happens, for example, when things are dramatized; people feel anxious. It can also be the opposite when information is downplayed… ah that’s not important… ah, cholesterol, no big deal,” Chong said.
Misinformation, Chong added, can cause delays for a person seeking medical help and getting timely treatment.
Cholesterol may be silent, killing you softly, but knowledge is power. Tatits faced cancer, but she took control of her heart health. Lau’s incident is a wake-up call—heart disease doesn’t discriminate by age. The good news? Unlike fate, cholesterol can be managed. With the right choices today, we can all unlock a healthier, stronger heart tomorrow.
This article is part of the Unblock Your Heart Health Reporting initiative, supported by the Philippine Press Institute and Novartis, to improve health literacy on cardiovascular diseases. Know your numbers, understand your risks, and consult your doctor—so no Filipino heart is lost too soon. Take control of your heart health today. Visit unblockedmovement.ph for more information.
This article is also published on Sunstar.com.ph.